After a lengthy and arduous period of decision making, our practice decided to do a limited implementation of EMR to achieve meaningful use. For us this means that we put in place the aspects of EMR that would support the first stage of meaningful use, and nothing more. We went live on this limited EMR last week, so now we can begin reflecting on the process.
My first observation is that few practices are taking this approach so the vendors are not prepared to train, educate, and support as readily as they might a more traditional implementation. The quote for number of training hours was excessively high (why would an optician who would rarely touch the EMR need eight hours of training?) and the training presentations deviated into content that was not be used. That being said, all of this was worked out before the staff were brought into the process so they were unaware of the discussions behind the scenes.
The doctors have been great about the entire process. There are a few who are probably mentally ready to go further, and this causes some problems with implementation. These doctors want to start loading information into parts of the EMR, but they can’t because we have to be consistent. Maybe this will accelerate our timeline to a full EMR, it is hard to tell. In the very least we have more champions for the next step, whenever it comes.
My last observation is the need to revisit the rationale for the decision to move forward in this limited implementation approach. Despite what seems obvious to those of us in the deep water of this project, many have forgotten why we went down this path. In particular a few of the owner physicians have forgotten. We would have benefited from additional communications about the rationale. We are going to do a formal presentation to the board of directors in the next couple of weeks. Without remembering how we got here it is too easy for the owners to cast doubt about the work being done and accidently share this with the staff; staff who might be stressed and struggling with the change.
It was the right decision for our group, and I would do it again. We came to this decision partly based on our struggles to get a consensus about EMR, and partly through help from the book Long Fuse, Big Bang by Eric Hazeltine. Haxeltine talks about the value of small, significant steps to achieve a larger goal. We are taking these smaller steps and making progress. Our organization will continue to learn as we go down this path. I also learn from my colleagues, and hope to be a resource for others.